Healthcare Provider Details

I. General information

NPI: 1396252318
Provider Name (Legal Business Name): EMG MEDICAL PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2017
Last Update Date: 11/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 MAIN ST
HACKENSACK NJ
07601-5804
US

IV. Provider business mailing address

329 MAIN ST
HACKENSACK NJ
07601-5804
US

V. Phone/Fax

Practice location:
  • Phone: 201-762-6050
  • Fax: 201-762-6050
Mailing address:
  • Phone: 201-762-6050
  • Fax: 201-762-6050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BEVERLY J DAVISON
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 516-297-4714